Marie Sherlock (Dublin Central, Labour)

I welcome this new community pharmacy agreement. We have a particular problem in Ireland whereby allied health professionals have not been able to operate to the top of their licence for many decades, whether that is a physiotherapist within a hospital setting or indeed a pharmacist within the community setting. While this agreement makes progress in this regard, it could go much further.

A second issue with regard to healthcare is that we have a lack of timely access to GPs in our community. It is no surprise that some of the greatest shortages are in rural communities or the most socially disadvantaged communities in urban settings. In the context of GP care becoming increasingly complex, and while we have fewer GPs per capita, there is a real need for pharmacists to be facilitated to operate to a much higher level. Although they have been trained to that level, those skills have not been utilised for a long period of time. The broadened scope of their functions now with regard to vaccination, the prescribing of contraception and the safe return of unused medicines is very much to be welcomed.

3 o’clock

It has been a particular bugbear of mine for a number of years, having had to deal with unused medications following the passing of family members. Some pharmacists have been good enough to take medications but others have not. Because of the inconsistency, there is enormous waste and inappropriate disposal of medication, so I very much welcome the change.

We know that the uptake rate for bowel screening is below what it should be. The target is about 50%. The response to a parliamentary question last week stated it is about 46%. Nonetheless, we need to see a much greater level of bowel screening and an increase in the age range of people undergoing screening.

There is a real issue with free contraception. For most healthy women, having to return to their GP every six months is a cost they should not have to bear. The service is now going to be available from within the pharmacy in terms of clinical consultation on the prescription. That is very welcome. However, we are concerned that there is nothing in the agreement about expanding the free contraception scheme. At the moment it is for women from 17 to 35 years. We believe it should go up to 45 years. The cost of that would be only €10 million, yet it would provide crucial access to contraceptive services.

We know that some pharmacists have done an excellent job in recent years with immunisation and flu vaccination, but I welcome the commitment to pharmacists participating in a catch-up scheme. We would push strongly for the Laura Brennan HPV catch-up programme to be rolled out within community pharmacies. Unfortunately, the Government made a decision to suspend that well over 12 months ago and we very much want to see it up and running.

The downside of the agreement is that we will see a very real and tangible impact on the most vulnerable, arising from the ending of phased dispensing for reasons 1 and 4 in the agreement. I am conscious the HSE has wanted to end phased dispensing for a considerable period, as there was an abuse of it by certain pharmacy groups. The reality is that it is going to have an impact in particular on those who are being cared for at home and who are trying to live independently - people who have a carer coming to the home. Carers cannot physically dispense the medication. They can just hand over the blister pack. Those with a visual impairment are also impacted. One pharmacist told me he only started to use phased dispensing some years ago when a person with a visual impairment came to him and said they wanted their medication to come in a blister pack. Phased dispensing could facilitate that arrangement.

I do not propose to go backwards, but what we need to do is ensure that there is a new support service for vulnerable persons within the pharmacy system so that vulnerable individuals, in particular those with mental health conditions, can access their medication on either a daily or a weekly basis and are not given heaps of boxes once a month or whenever the prescription is dispensed, as that can be dangerous. If we are truly serious about trying to keep people at home and prevent greater hospitalisation, then we have to think very carefully about phased dispensing.

While it is related to phased dispensing, it was the pharmacist's own decision to use the blister pack service. What pharmacists have been doing for a number of years is using the money from phased dispensing to effectively employ somebody to put the blister pack service together for their patients, again, for the reasons I outlined, for those very vulnerable patients. Those patients are now going to be asked to pay for that very valuable service. As somebody said, it is the Jurassic Park of medical technology and yet it works in terms of allowing people to know that they are taking their medication the right way every day. It also allows families to know that their loved ones are taking their medication in the right way every day. I am concerned that some people will not sign up to pay because they cannot afford it or they will not see the benefit of paying for it. I know savings are specifically allocated within the agreement, arising from the ending of phased dispensing. My appeal to the Minister and to officials in the Department is that we would have a support service for vulnerable persons.

A related issue is the hardship scheme. My experience is that its application has been very inconsistent across areas because it is a discretionary scheme. It is for medical card patients whose item is not on the PCRS list, but it is for the network health offices to make the determination and only if they have the funds to do so. We need to change that and make sure that there is a much more consistent hardship scheme in place and that the criteria are much more apparent, which ultimately makes life easier for pharmacists, by giving them clarity, and most particularly for GPs and crucially for patients themselves, so that they will be able to avail of it. It is not good enough if somebody who is prescribed medication then finds out that they cannot get it after a pharmacist and GP have sent off the forms to see if the patient can get it, and then to have to go back to the GP to get other medication. That is a huge inefficiency that we need to do away with.

One of the final two issues I want to raise is the cost of the drugs payment scheme. The budget is coming up next week and we very much believe that in a cost-of-living crisis, the State can play a key role for those families who are relying on the drugs payment scheme and reduce their prescription costs. It needs to go lower, to €50. The reality is that if it costs €78 million, it would have a very real and tangible impact on those families who are suffering from the cost of living. Those with a disability and people who are not able to work full-time hours because of chronic conditions are most reliant on medication and if they do not qualify for a medical card, they end up forking out a lot of money every month, €80, through the drugs payment scheme, so we want to see it reduced.

The final point I want to make in the remaining minute relates to the shortage of certain medications. We understand there are currently 335 notified shortages. There is a very well-flagged shortage of the Estradot patches, the HRT medication. Ultimately, there is much frustration on the part of women. I have heard pharmacists and women describe all sorts of ingenious and creative ways they have had to come up with to try and make the medication stretch, and to find substitutes. My sense is that there is a lack of co-ordination within the Department in this regard. I know there has been a call for some time for the establishment of a chief pharmaceutical officer role in the Department. Obviously, there is no magic wand for any of these issues, but we need greater leadership to provide certainty to patients regarding product shortages. At the moment, too many women in particular are being failed because of the shortage of HRT, as well as people relying on other medication as well.

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